Sequential whole-body PET/MR scanner: concept, clinical use, and optimisation after two years in the clinic. The manufacturer's perspective.

PET and MRI are established clinical tools which provide complementary information, but clinical workflow limits widespread clinical application of both modalities in combination. The two modalities are usually situated in different hospital departments and operated and reported independently, and patients are referred for both scans, often consecutively. With the advent of PET/MR as a new hybrid imaging modality there is now a possibility of addressing these concerns. There are two different design philosophies for integrated PET/MR imaging-positioning PET inside the MRI magnet or in tandem, similar to PET/CT. The Ingenuity TF PET/MR by Philips Healthcare is a sequential PET/MR tomograph combining state-of-the-art time-of-flight PET and high-field MRI with parallel transmission capabilities. In this review article we describe the technology implemented in the system, for example RF and magnetic shielding, MR-based attenuation correction, peculiarities in scatter correction, MR system optimisation, and the philosophy behind its design. Furthermore, we provide an overview of how the system has been used during the last two years, and expectations of how the use of PET/MR may continue in the years to come. On the basis of these observations and experiences we discuss the utility of the system, clinical workflow and acquisition times, and possible ways of optimization.

Time-of-flight PET/CT using low-activity protocols: potential implications for cancer therapy monitoring.

INTRODUCTION: Accurate quantification of tumour tracer uptake is essential for therapy monitoring by sequential PET imaging. In this study we investigated to what extent a reduction in administered activity, synonymous with an overall reduction in repeated patient exposure, compromised the accuracy of quantitative measures using time-of-flight PET/CT. METHODS: We evaluated the effect of reducing the emission count statistics, using a 64-channel GEMINI TF PET/CT system. Experiments were performed with the NEMA IEC body phantom at target-to-background ratios of 4:1 and 10:1. Emission data for 10 s, 30 s, 1 min, 2 min, 5 min and 30 min were acquired. Volumes of interest fitted to the CT outline of the spheres were used to calculate recovery coefficients for each target-to-background ratio and for different reconstruction algorithms. Whole-body time-of-flight PET/CT was performed in 20 patients 62+/-4 min after injection of 350+/-40 MBq (range 269-411 MBq) (18)F-FDG. From the acquired 2 min per bed position list mode data, simulated 1-min, 30-s and 15-s PET acquisitions were created. PET images were reconstructed using the TOF-OSEM algorithm and analysed for differences in SUV measurements resulting from the use of lower administered activity as simulated by reduced count statistics. RESULTS: In the phantom studies, overall we identified no significant quantitation bias over a wide range of acquired counts. With acquisition times as short as 10 s, lesions as small as 1 cm in diameter could still be identified. In the patient studies, visual analysis showed that emission scans as short as 15 s per bed position sufficiently identified tumour lesions for quantification. As the acquisition time per bed position decreased, the differences in SUV quantification of tumour lesions increased relative to the 2-min reference protocol. However, SUVs remained within the limits of reproducibility required for therapy monitoring. Measurements of SUVmean within the region of interest were less prone to noise than SUVmax, and with the 30-s per bed position 95% confidence limits were +/-11% or +/-0.7 SUV. CONCLUSION: Short time acquisitions, synonymous with reduced injected activity, performed on a TOF-based PET/CT system are feasible without encountering significant bias. This could translate into clinical protocols using lower administered activities particularly for serial PET studies.

Externally triggered gating of nuclear medicine acquisitions: a useful method for partitioning data.

Physiological gating in nuclear medicine image acquisition was introduced over 30 years ago to subdivide data from the beating heart into short time frames to minimize motion blurring and permit evaluation of contractile parameters. It has since been widely applied in planar gamma camera imaging, SPECT, positron tomography (PET) and anatomical modalities such as x-ray CT and MRI, mostly for cardiac or respiratory investigations. However, the gating capability of gamma cameras and PET scanners can be employed to produce multiply partitioned, statistically independent projection data that can be used in various ways such as to study the effect of varying total acquired counts or time, or administered radioactivity, on image quality and multiple observations for statistical image analyses. Externally triggered gating essentially provides 'something for nothing' as no data are lost and a 'non-gated' data set is easily synthesized post hoc, and there are few reasons for not acquiring the data in this manner (e.g., slightly longer processing time, extra disk space, etc). We present a number of examples where externally triggered gating and partitioning of image data has been useful.